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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
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Early Detection of Iron Overload Cardiomyopathy in Transfusion Dependent Thalassemia Patients in Sulaimaniyah City,

Rana Adnan Ahmed1, Aso Faeq Salih2, Shirwan Hamasalih Omer1

  • 1Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq.

Therapeutics and Clinical Risk Management
|March 29, 2022
PubMed

Insights

Transfusion-dependent thalassemia (TDT) patients show early cardiac changes detected by ECG, echocardiography, and plasma BNP. Serum ferritin levels did not significantly aid in early detection of these cardiac issues in TDT.

Area of Science:

  • Cardiology
  • Hematology
  • Pediatrics

Background:

  • Transfusion-dependent thalassemia (TDT) necessitates lifelong blood transfusions, leading to iron overload and potential cardiomyopathy (CM).
  • Early detection of cardiac complications in TDT is crucial for managing patient health and preventing adverse outcomes.

Purpose of the Study:

  • To evaluate the accuracy of electrocardiographic (ECG) data for arrhythmia risk assessment in TDT patients.
  • To detect early structural and functional changes in the left atrium and ventricle using ECG and echocardiography (including Doppler studies).
  • To explore correlations between plasma B-type natriuretic peptide (BNP)/serum ferritin and ECG/echocardiographic findings in TDT.

Main Methods:

  • A prospective case-control study involving 75 TDT patients and 74 controls (mean age ~9.7 years).
  • Assessment included socio-demographics, physical exams, serum ferritin, plasma BNP, ECG, 2D echocardiography, and tissue/pulse wave Doppler.
  • Comparison of cardiac biomarkers and imaging parameters between TDT patients and healthy controls.

Main Results:

  • TDT patients exhibited significantly higher serum ferritin and plasma BNP levels compared to controls (p<0.001).
  • ECG revealed increased P-wave dispersion, QRS duration, QT duration/dispersion, and JTc dispersion in TDT cases.
  • Echocardiography showed diastolic dysfunction with preserved ejection fraction, increased left ventricular mass, dimensions, and posterior wall thickness in TDT patients (p<0.05).
  • A significant correlation was observed between BNP and QT dispersion (p<0.05).

Conclusions:

  • ECG, 2D echocardiography, Doppler studies, and plasma BNP are valuable tools for detecting early cardiac changes in TDT.
  • Serum ferritin levels did not show a significant benefit in identifying early cardiac alterations in this TDT cohort.
  • These non-invasive methods aid in the early diagnosis and monitoring of cardiac involvement in TDT patients.
Abstract

Keywords:
blood transfusioncase-control studyhereditary diseaseiron overloadthalassemia complications

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